Medication Administration - PDF by ids65105

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									Medication Administration

  I. Kevin Johnson,
 AS,BS, NREMT-P
 Paramedic Program
      Inver Hills
 Community College
         Drug Preparation

Medication Order
– Medication desired
– Dose desired
– adminstration route
– adminstration rate
Write it down!
Read Back Order!
      Five Rights of
 Medication Administration
Right Patient
Right Medication
Right Dose
Right Route
Right Time
General Administration Routes

Alimentary Tract
– Oral
   » 35 - 40 minutes to effect
– Sublingual
   » works within minutes
– Rectal
   » somewhat slower than oral route
   » best used in pediatric patients
General Administration Routes

Parenteral routes
– Topical
   » varied rate of absorption, long duration
– Intradermal
   » absorption very slow, (allergy testing)
– Subcutaneous
   » injected into fatty tissue under skin
   » rate of absorption slower than IM or IV
   » Maximun of 2 ml can be given
General Administration Routes

Parenteral Routes
– Intramuscular
   » drug injected directly into muscle tissue
   » predictable rate of absorption, slower than IV
   » linited to 10 ml in large muscle
– Intravenous
   » Rate of absorption rapid and predictable
   » highest potential for producing adverse reactions
General Administration Routes

Parenteral Routes
– Endotracheal
   » rapid absorption into bloodstream
   » narcan, atropine, valium, epi, lidocaine
   » must double the usual dose, dilute with 10cc NS
– Sublingual injection
   » only when IV or ET can’t be established
        lidocaine most common drug given this route
– Intracardiac
   » direct injection of meds into heart muscle
General Administration Routes
Parenteral Route
– Intraosseous
   » used in children when IV can’t be started
   » as fast absorption as IV
– Inhalation
   » respiratory nebulizers and inhalers
   » ammonia
– Vaginal
   » suppositories
   » limited area of effect
       Injection Equipment

Needle
– sized for gauge
   » 25 ga for SQ injection
         1/2 - 5/8 inches long
   » 19 - 21 Gauge for IM injection
         11/2 - 2 inches long
– Don’t draw blood with less than 21 Ga.
– Needle should be changed if used to draw up
  med via a multi dose vial
                  Syringes
Tuberculin Syringe
– intradermal/SQ injections
– holds 1 cc
   » calibrated in 10ths of a CC
Standard Syringe
– SQ or IM injections
   » Calibrated in CC or mL or minims
Insulin syringe
– used only for injecting insulin
– 1 cc and calibrated in units
             Subcutaneous Injection
                    Tuberculin Syringe




                                   45 Degree Angle
                                   to the Skin
 Epidermis

  Dermis

Subcutaneous
    Fat                           Injected into SQ tissue
     Subcutaneous Injection
Assemble Equipment - Check Dosage
Identify Patient and explain procedure
Put on Gloves, Clean Site
Pinch skin fat into fold of at least 1 inch
Insert needle at 45 degree angle
Pull back on plunger, look for blood
Inject slowly
withdraw and discard syringe
Monitor Patient for effect
             Intramuscular Injection
               3 to 10 cc syringe




                                    90 Degree ancle
                                        to skin
 Epidermis

  Dermis

Subcutaneous
    Fat

  Muscle
           IM Injection
Draw up medication and check dose
locate injection site
Put on gloves and cleanse site
Stretch skin taut at injection site
Insert needle at a 90-degree angle
Draw back plunger & check for blood
Inject at a slow and even rate
Rapidly withdraw needle
Discard needle and observe patient
             Z-Tracking
Draw up and prepare meds as before
Stretch skin at site as far as you can to one
side
Cleanse site and inject drug
Wait 10 seconds and withdraw the needle
Withdraw and allow skin to return to
normal position
Do not massage site
Discard Needle and observe patient
     Intravenous Administration

Two distinct Methods
– IV Bolus
– Slow IV infusion
   » drip or pump (piggyback)
           IV Medications

Draw up correct medications
Cleanse injection port of tubing
Clamp tubing above injection port
inject drug at a proper rate for the med used
Briefly open IV line to flush tubing
– raise arm to facilitate circulation
dispose of needle and observe patient for
effects.
 Endotracheal Administration

Only good for Certain Emergency Drugs
– NAVEL
Good site is patient is tubed prior to IV
Dose must be 2-2.5 times usual dose
– diluted to 10 cc of NS
Ventilate Immediately
 Intraosseous Administration

generally indicated for children under the
age of 6 when a peripheral IV cannot be
started.
Must be securely fastened to leg
– any movement may enlarge hole and leak
   Inhalation Administration

Metered dose inhalers
– common but most ineffective for severe
  emergencies
Nebulizer
– effective way to give meds to patients in severe
  distress.
       Indwelling Cathetors

PICC line
– used in patient’s required IV Therapy over a
  long period of time
Port-a-Cath
– sugically implanted vascular access device
Hickman Cath
– External central catheter

								
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